Somewhere between writing and doctoring.

Dustfall

I have been asked the question, several times, ‘why did you set a novel about medical error up in Wittenoom?’ It’s a fair question really.

I have to answer this a little blind. Most novels arise from some odd place; they spill forth from the subconscious organ, wherever that is. Brain? Behind the spleen? Who knows. As most neuroscientists admit, we do not understand the creative process in the slightest.

All I knew is that a mistake I had made in the infancy of my career had stayed; fashioned itself into something solid, grew a little bit each year, beyond all the other mistakes, and started courting words. It wanted to be written.

So we faced the blank page, me and my brain, not really having any idea how to do this novel-writing business, and began. And the moment I did, needing to send my fallen doctor, somebody who had made an unforgivable mistake and was slowly dissolving in the acid of her own contempt, somewhere, the image of the abandoned, ruined hospital of Wittenoom flared true and bright in my head.

I’d travelled to that far-flung ghost town, which stayed clawing on for life with talons of ego and madness, battling all attempts by the Government to shush it out of existence, when I was a soft, unscarred intern. I had found myself alone and lost in the crumbling wreck of the hospital, the walls falling down, but gauze still on the floor and journals stacked and waterlogged in the corner. It was the strangest place I had ever seen. Eerie beyond imagining. The bricks from the walls were toppling, perhaps releasing the ghosts trapped in there, one by one. Relics of equipment were untouched, covered in dust. Dingoes howled nearby. Asbestos fibres floated in on the desert breeze.

But, life needed to move on. I shifted back down to Perth, and folded away anything that was not needed to survive a lifetime trying to become an Emergency Physician. However, when the book began to wriggle out of me, here it was. This hospital. This image. This place. And with this came the research. Which is why Dustfall came to be about the story of a brutal chapter in Western Australia’s history, but even more so, the story of the contempt that some corporations and Governments have for human life. The victims, the dead, those who suffered at the hands of others, they deserved a voice. It was a tough book to write, but through the extraordinary help of others, it is now on paper. In stores. People occasionally read it, and for every soul that takes the time to do so, I will never be able to express the extent of my gratitude.

I’m also asked, once in a while, whether the process was cathartic. Well here’s the bad bit. Right now, I’m not entirely sure whether I have survived. At the moment I’m taking a few months away from the hospital. Away from Emergency Medicine. God, I hear you say, not another one.

I don’t particularly want to write about this blindsiding vulnerability – (oh how wonderful is it to appear invincible, in control, untouchable) – but, I am a writer, and the only way I can truly think is with these things; these words, sentences, thoughts, coming from my fingertips.

After all this time, to feel a tiny bit broken, feels the truest kind of failure. We hear a lot about failure – how it is the only way to learn, how it allows us to rise up and grow, like we are some kind of gaseous villain in a superhero movie. But I’m not sure it’s always like that. For some, it’s a pervasive, long term ‘not good enough.’

Medicine, we are beginning to learn, has been a powerful force amplifying that message. You are not good enough.

The compassion equation no longer adds up. While we know that we must reach deep, every single day, into our well of compassion to be half-decent clinicians, the same cannot always be said for those who stand over us, with their administrative roles and executive titles. An unexpected culture of mutual disrespect and suspicion about motives has somehow infested many of these relationships, and it is not clear how to find our way out.

We know the health dollar is limited. We know that agitating for individuals is sometimes at cross-purposes to the greater good when it comes to budgetary allocation. We know we must work to make our systems as efficient as possible. But to come away believing that one’s efforts are not good enough, is, over time, damaging.

I am no stranger to the not good enough mantra. I am, after all, female. I see the same wounds from the same words in others – people whose first language is not English, in the voices of our First Nations people whose lives intersect mine, those with illness/disability. Not good enough. For what, one could rightly ask? Who knows, but we have a society that, more and more, seems to enjoy empowering the voices of the strong – those who feel entitled to make others whisper such words to themselves. Have current global events contributed to this anti-mantra? Where oppression of any voice other than that of wealthy white people goes unfettered? I would like to say wealthy, white men, as it mostly is, although it seems to be the first two adjectives that appear the most in this picture.

I’m not good enough on social media. I’m a fool, at my age, to even care. But I do. I see all the things I should be doing, particularly in critical care, to be a decent clinician, and I know I can never be that person. Why am I not that person, I ask? I also watch the mob-think, the pile-ons, people tossed into the colosseum, and I sit back, aghast. What have we unleashed?

But then, as I look outwards for reasons why I’m sitting here, writing this, I wonder, is the enemy simply inside myself? Am I the cruel prison-guard of my own bruised worth?

There is, though, something rotten going on outside.

When I started writing Dustfall it was 2011. I thought I was writing something historical. That crushing individuals who are on the lower end of the power relationship see-saw was slowly becoming a thing of the past. The world was progressing. Tolerance, globalism, respect, although moving in fits and starts, was heading in the right direction. But I look at our planet now and wonder. I look as countries leak refugees, the result of war-loving men who wear their murderous decisions like epaulettes, the millions affected fleeing to countries which lock up wide-eyed children or push their boats away hoping they might silently drown. ‘Jobs’ trumps climate change, coin beats species loss, tourism beats Indigenous treaties. Women are not believed, lies from the top are.

What are we doing wrong? How do we fix it? Apart from trying to keep a tiny beacon alight, trying to show others the respect you believe is fundamental to our connectedness as humans, I’m not sure. Maybe this is my only advice. If you’re feeling not good enough, then chances are somebody else is too. And those personal connections, not advertised, not instagrammed, where you find yourself in the company of trust and respect, are kind of amazing. And if all else fails, write.

(as a post script, in the light of the inconceivable horrors going on in the US – just for one example, the slaughter of peace-loving Jewish people in their synagogue during a baby naming ceremony – I am re-reading Primo Levi’s If This is a Man. I needed some perspective on the world. What is a man, indeed? I highly recommend it.)

Plus – on the topic of ‘not good enough’, a recent post by the beautiful Shahina Braganza https://shahinabraganza.com/blog/wellness/was-i-enough/

You may be wondering why the top copy of Penelope Lively’s Moon Tiger has slipped off her pile and is teetering on its back without dignity. Pushed perhaps; back-handed and left floundering like a flipped tortoise. I know why, but it took me some time to figure out. The carpet underneath these two innocent-looking stacks is a sensible shop-brown, as you can see, and covers the steps towards the back of an out of the way bookstore in a lane in the middle of a Perth suburb of unseemly prosperity. You can’t walk up these steps; they are covered in books. Books to be sold, books to picked up and paged through, books to be put back down again when their blurb is not sufficiently enticing or the protagonist has not called out loudly enough to the distractible browser. That is my book, next to Penelope Lively’s. THE Penelope Lively, Booker prize winner, Golden Booker pursuant, goddess of story and character and altogether blisteringly magnificent bookwright. My first reaction, upon seeing my book next to hers, was unclear, a little soupy. Was it a feeling of delight unsure how to embody itself – oh there I am, yes, that’s me, oh no, nothing really, no don’t worry, oh yes, ha ha that IS my book next to Penelope’s – or was it more a deadly slug of imposter’s guilt (I must move it before anybody notices and makes some sort of curare-like comment)? I would take a photo anyhow; record the moment, in case this dizzying proximity proved temporary. Why, though, I know you are asking, was the top of her pile tipped backwards, blood rushing to its head, whilst my pile, although not Euclidean in perfection, was at least orderly.

We must turn our clocks forward several hours to find out. Everybody must leave, the lights must be switched off, and the heavy lock on the door latched shut for the night before the mystery can be solved.

If you’re reading this, then you are the sort of person who understands that there is something otherworldly about bookshops. They’re non-Newtonian. Normal rules don’t apply. It’s at night time that the readers, the sellers, the wanderers, the eagle-eyed, those of us who drearily adhere to the constructs of the universe’s physical laws, when all of the people, anybody with mildly human form, obediently leave.

And that is when others arrive.

At night, Claudia, from the depths of Moon Tiger, stretches her long, sensuous limbs, and slinks out of her pages. She has not been to Australia before; Penelope sent her many places, but not here. She is faintly, and briefly, repulsed. The sneer of the sun has faded a patch of carpet nearby. The room seems safe and lazy; neither are qualities she admires. She sniffs. She is sure she can smell beer. It’s yeasty, whatever it is. She perches above her pile of books, and crosses those shapely pins. I shall wait, she thinks. Good things come to me. They always have. Tom, might be here, she thinks with a start. After all, if no laws apply, and I am here, why can’t he be. Her stomach contracts, her throat tightens. She puts a hand to that now world-famous red hair, hoping it survived the exit from the pages. And she waits.

Unhappily for Ms Hampton, who sits, twirling the back of an earring, looking serene on the outside while she is all anticipatory turmoil on the inside, it is not Tom that turns up, but Raymond. Dr Raymond Filigree has snuck out of Dustfall, and is looking around, confused. He is not confused because he is in a Perth bookshop, at night; not the size or the flesh or the universe he thought he ought to be inhabiting, but because he is always confused. You see, while both Raymond and Claudia could escape their books, they could not escape their characters. They seem to be the only two who’ve had the temerity to climb from their paragraphs this night, certainly up on the step area. Several other characters are milling around other shelves further away, but they are too small to climb down, their voices too slight to call out.

I would love to tell you that Raymond and Claudia got on famously; that Claudia inhabited her role of journalist and peppered Raymond with questions about Wittenoom, fascinated by the corporate and government cover-ups and their contempt for human life, and that Raymond would have melted at the sight of Claudia, completely forgetting about the odd, angular, widowy looking Miss Rosa hanging around in her cabbagey kitchen back in the book. I don’t pretend to understand why, but they detested each other immediately. I could sit here, on this page, pontificating why that might have been, but I will never know this part. It’s all second-hand reports, you see.

There’s conflicting acounts as to how Moon Tiger was toppled. It happened sometime near dawn. It seems as though Claudia, distraught that she wasn’t going to spend her precious time watching the sun rise from a slow-moving train in Egypt, drinking the last drops of gin from a crystal tumbler, gazing as the colours of the Nile morph from gold to pink to the shimmer of white daylight, while great herons and ibises fly by in streaks, not in the company of Tom’s powerfully evanescent beauty, threw what could only be described as a tantrum, leaving Raymond silent and apologetic in that English way of his, sorry that he hadn’t realised until too late her distress.

And then it is over. The bookseller unlocks the door, and comes into work for the day, She tidies up some of the piles of books, but not this one. Perhaps she knows too. She is a bookseller after all.

Doctors, the world over, are reeling. The global telegraph has been alight with conversations, most of them uncomprehending, shocked, dismayed, fearful. In several swift and definitive decisions, a UK paediatric trainee, Dr Hadiza Bawa-Garba was not only erased from the GMC register, but charged with manslaughter. This was in response to several medical errors – most of them oversights when the details are examined – which contributed to the death of a child in hospital. I have no intention of going through the case here, which has been expertly picked over by a good many sources. Suffice to say that Hadiza was slung to the lions, the consultant in charge leaving her naked, her hospital, her trust, the regulatory bodies entrusted with safety of both doctors and patients, all turning their backs to leave her to her professional demise. All for several decisions made when she was covering extra shifts, in a climate of heinous understaffing, and trying to manage a deluge of patients when she had just that day returned from maternity leave, unsupported and abandoned to her fate.

So much is baffling about this case and its horrific outcome. Nobody wants a child dead from misadventure. It is tragic beyond the reckoning. But for the regulatory bodies to kick back with the tendon strike and sacrifice an individual so? Is Hadiza supposed to be an example, like a spiked head at the entrance to the Thames? Unquestionably these decisions will serve to endanger patient safety in the future. Individual blame always does this, driving self-reflection and honesty underground.

Hospital systems are almost incomprehensibly complex. Patient safety is paramount, but the infinite interactions that occur within them will likely always outfox the desire to provide foolproof polices and structures. You can’t legislate for the illimitable.

The outcome of this case is extreme, but so many of the occurrences are commonplace. Without any desire to misappropriate a worthy movement, is this another instance of #MeToo?

We inside the beast are always going to make mistakes. Always. Most of them are small; oversights, errors of judgment, succumbing to biases, betrayal by the impossible circumstances in which we sometimes work. Most picked up by the lumbering checks and balances designed to avoid them.

No doctor ever wants to make mistakes. In fact, cheered on by cases like Hadiza’s, we, and the world we serve, see medical error as utterly unforgiveable, a deep personal failing. Doctors, for many reasons, are not very good at failing. I know what it feels like. I expect my experience is nothing special, but I know what it’s like to wake repeatedly in the early hours, my gut twisted and writhing re-asking myself why I thought a certain thing, or missed another. I know what it’s like to hide in the department toilets, trembling and wiping away unstoppable tears. I am on intimate terms with disgust. I know what it’s like to think, perhaps if I end it all… I know what it’s like to stopper in the shame and humiliation that comes with the perception of not being good enough. Mostly our punishment is a deafening, roaring monster within ourselves. And, if we are very, very lucky, we get a system that allows us to self-reflect, even better with some empathetic human support, and even better a respectful, inclusive way to analyse the system errors, which, almost always, are more contributory to any error than the part the individual played.

I’ve thought a great deal about the consequences of medical error. I wrote a novel about it. It’s the core of Dustfall. If perhaps a handful of people read the book, either medical, or not, and see into the heart of a doctor after failing a patient, then perhaps the six years of sentence struggling will be worth it.

Dustfall. I’m with you, it’s an odd word. It is, however, the title of my first novel, and somewhere within it is the semblance of sense.

Dustfall is a book 6 years in the making. Its release date is February 2018, and it’s being published by UWA Publishing, a cracker of an independent press who produce quality books of both non-fiction and literary fiction flavour.

When I was an intern (let us not lower the tone of this post by mentioning the year), I was flung out to Port Hedland Hospital for a term (my second only as doctor, the first being ten weeks in psychiatry), during which I was occasionally rostered on to staff the Emergency Department, alone, overnight. As you will easily imagine, this was a rather formative period for me. Frankly terrifying doesn’t begin to encapsulate it. Several times during this stint, searching for solace, I travelled round the surrounding countryside – that parched, red, horizonless outback of ours. On one of these occasions, I ended up in Wittenoom, a crumbling, soon to be ghost town. Amongst the shadows and the ruins, I came across the abandoned Wittenoom Hospital, and wandered through its shell, its broken corridors, its clanging, destroyed rooms. It was like the Mary Celeste – looking as though it had been abandoned in a hurry, with no one set to come back. Gauze rolled through the corridors, waterlogged piles of journals sat off to one side, and an old anaesthetic machine, a strangely shiny relic, gleamed in the corner. This image has stayed with me for decades, and I always knew there was a story to be had there.

Of course, Dustfall is a work of fiction, but it explores the crashing consequences of a doctor’s single mistake, as well as shining a light on a heinous chapter in Western Australia’s mining history.

More than this, I won’t say for the moment. Over the next six months, leading up to release date, there will be lots of news and numerous updates, most of which will find their way here.

It’s been a journey of wonder, writing the manuscript. A personal campaign of learning, of failure and rejection, and the rediscovery of the immense power and sublime beauty of the written word.